Many people with shy bladder first visit a urologist to find out if there is something physically wrong.
The urologist's role is to:
- check to make sure there is no related medical issue
- assure the patient that he or she is not alone
- suggest changes such as scheduling voiding and, for men, using a private toilet rather than a urinal
- teach the patient self-catheterization
- send the patient to a specialist in anxiety disorders for cognitive therapy and graduated exposure therapy
Of these approaches, self-catheterization leads to relief right away and better quality of life. The low risk for healthy people in using catheters far outweighs the harm of ongoing disruption of one`s life by shy bladder .
No controlled studies of the treatment of shy bladder syndrome have been published. But behavioral exposure therapy (exposing you to what you fear) has been said to be helpful. Other methods that have been used with mixed results are:
- paradoxical intention (worrying on purpose)
- sphincter botulinum toxin injection (to control muscle activity)
- surgery (transurethral microwave therapy, transurethral resection of the prostate)
People with shy bladder may also benefit from drug therapy. For some, antidepressants (like selective serotonin reuptake inhibitors) help reduce worry so that behavior therapy can start to work. But it is important to note that drug therapy for shy bladder has not been proven to work well. Interestingly, the standard urological treatment with alpha-blockers has also not been proven to work at this time.